My patient yesterday had a total hip replacement on Tueasday. One of his scheduled meds was Lovenox. This anticoagulant is a low-molecular weight Heparin. Lovenox inhibits factor Xa and thrombin. According to the article I read, researchers evaluated the pathway efficacy using patient data forms and financial databases. Before instituting Lovenox, the average length of stay after a total knee or total hip replacement was 4.41 days. After instituting Lovenox, the stay average fell to 3.24 for total hip and 2.98 for total knee. Survey results showed high patient satisfaction rates, and the survey showed no increase in complication rates or readmissions. Key elements contributing to the success of any new pathway of treatment include preoperative patient education, standardized orders derived from evidence-based medicine, and team coordination. Quality of care, patient satisfaction, and patient saftey are the primary goals.
"Success of Clinical Pathways for Total Joint Arthroplasty in a Community Hospital"
FL Walter, N Bass, G Bock 2007
The Other Side of the Stethoscope...
Having the heart of a teacher and the hopes of being a nurse, this book captured my undivided attention after the first page. This is a difficult read. It isn't difficult in words or length, but in that it reaches down into your own fears and makes you take a look at how fragile life really is. It made me think of something that happened yesterday, and so I will relate it to you. I don't know the wisdom in doing so, but therein lies the danger of asking for one's opinion.
At 0800 my patient was scheduled for Lovenox. Good! I thought. One that I know a little about. I had given a Lovenox shot last winter, and I did remember how that needle closes itself off with one final push on the plunger. I also know that it is a low-molecular type of Heparin, interferes with factor Xa, watch for bleeding, and so on. Ms. Williams went with me. I had told her about the med and she seemed satisfied with my answer. I went into the room with my head full of thoughts. My thoughts were so loud it is a wonder my patient could not hear them. My thoughts were as follows...put on gloves, ask for two identifiers, check identifiers on armband, give multi-vitamin first, I have already spoken with him enough to know that he is intelligent so don't insult him by asking if he knows what a vitamin is, tell him about Lovenox (not too much, not too little...but what will Ms. Williams see as too much??? too little???), prep the site, not too close to umbilicus...go for muffin top, go straight in...it is subQ but there is plenty of meat in muffin top, and close off that needle, put it in sharps container, and for God's sake don't make any mistakes Kim, you are being watched. Your whole future rides on doing well in nursing, and on, and on... We come out and I'm thinking I did ok. A very thoughful Ms. Williams told me that my whole personality changed when I went in that room. She said I acted too stiff and that she feels I need to be more relaxed so my patient will be more relaxed. Don't get me wrong, she was just being honest with me. A trait I find so little of these days. And she was right. I went in that room so tense that if you could have harnessed the energy in my back and neck muscles you could have lit up New York city for several hours. I wasn't thinking of how my patient was feeling at that moment, I was thinking of how hard I have worked to get here, how much time I put into studying (and how it feels like it doesn't help sometimes), and how exhausted I am. We all have problems, and we all carry a weight around with us. But as Marcus wrote in his book, the nurse is there for the patient. When we walk in that door, it isn't about us...it's about them. I will try to drop my overwheming thoughts at the door before I enter a patient's room. And honestly, when it's just me and my patient, I seem to do just fine. I'll bet you, the reader, if you know me at all would find it funny that I was at a loss of words or ease with this patient or with anyone at any time for that matter! However, the ominous feeling of being watched and graded is terrifying. I am only human, or at least, that's what my husband keeps telling me. And Ms. Williams, if you are reading this, thank you for your honesty. I prefer honesty over southern ideas of charm any time.
"Success of Clinical Pathways for Total Joint Arthroplasty in a Community Hospital"
FL Walter, N Bass, G Bock 2007
The Other Side of the Stethoscope...
Having the heart of a teacher and the hopes of being a nurse, this book captured my undivided attention after the first page. This is a difficult read. It isn't difficult in words or length, but in that it reaches down into your own fears and makes you take a look at how fragile life really is. It made me think of something that happened yesterday, and so I will relate it to you. I don't know the wisdom in doing so, but therein lies the danger of asking for one's opinion.
At 0800 my patient was scheduled for Lovenox. Good! I thought. One that I know a little about. I had given a Lovenox shot last winter, and I did remember how that needle closes itself off with one final push on the plunger. I also know that it is a low-molecular type of Heparin, interferes with factor Xa, watch for bleeding, and so on. Ms. Williams went with me. I had told her about the med and she seemed satisfied with my answer. I went into the room with my head full of thoughts. My thoughts were so loud it is a wonder my patient could not hear them. My thoughts were as follows...put on gloves, ask for two identifiers, check identifiers on armband, give multi-vitamin first, I have already spoken with him enough to know that he is intelligent so don't insult him by asking if he knows what a vitamin is, tell him about Lovenox (not too much, not too little...but what will Ms. Williams see as too much??? too little???), prep the site, not too close to umbilicus...go for muffin top, go straight in...it is subQ but there is plenty of meat in muffin top, and close off that needle, put it in sharps container, and for God's sake don't make any mistakes Kim, you are being watched. Your whole future rides on doing well in nursing, and on, and on... We come out and I'm thinking I did ok. A very thoughful Ms. Williams told me that my whole personality changed when I went in that room. She said I acted too stiff and that she feels I need to be more relaxed so my patient will be more relaxed. Don't get me wrong, she was just being honest with me. A trait I find so little of these days. And she was right. I went in that room so tense that if you could have harnessed the energy in my back and neck muscles you could have lit up New York city for several hours. I wasn't thinking of how my patient was feeling at that moment, I was thinking of how hard I have worked to get here, how much time I put into studying (and how it feels like it doesn't help sometimes), and how exhausted I am. We all have problems, and we all carry a weight around with us. But as Marcus wrote in his book, the nurse is there for the patient. When we walk in that door, it isn't about us...it's about them. I will try to drop my overwheming thoughts at the door before I enter a patient's room. And honestly, when it's just me and my patient, I seem to do just fine. I'll bet you, the reader, if you know me at all would find it funny that I was at a loss of words or ease with this patient or with anyone at any time for that matter! However, the ominous feeling of being watched and graded is terrifying. I am only human, or at least, that's what my husband keeps telling me. And Ms. Williams, if you are reading this, thank you for your honesty. I prefer honesty over southern ideas of charm any time.
